Tax Day And Health Insurance Under Trump

People who lacked health insurance for more than three consecutive months in 2016, or who bought individual insurance and got federal help paying the premiums, will need to do a little work to figure out what, if anything, they owe the IRS.

Brennan Linsley
/ AP

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Originally published on April 17, 2017 12:04 pm

Your federal income taxes are due April 18 this year, and — for perhaps several million people — a fine for failing to get health insurance is due that day, too.

Despite a lengthy debate, Congress has not yet acted on a bill to repeal portions of the Affordable Care Act. That means the law and almost all of its regulations remain in force, at least for now.

For the majority of tax filers, who had health insurance through an employer for 2016 or through a government program, all they have to do is check the box on the 1040 form that says they were covered for a full year. That's it.

The Obama administration had called for the IRS to begin rejecting tax returns for 2016 that left that box blank. But the IRS under the Trump administration has canceled that policy, citing a Trump executive order that calls on federal agencies to "minimize the burden" of the health law.

Still, those who lacked insurance for more than three consecutive months, or who bought individual insurance and got federal help paying the premiums, need to do a little more work to figure out what, if anything, they owe.

Those with no insurance, and those who have had a lengthy gap in coverage, may be required to pay what the federal government calls a "shared responsibility payment." It's a fine for not having coverage, on the theory that even those without insurance will eventually use the health care system at a cost they can't afford, which means that someone else -- other patients, hospitals, health care providers and taxpayers — will have to pay that bill.

Many people who don't have insurance, however, qualify for one of the several dozen "exemptions" from the fine. Nearly 13 million tax filers claimed an exemption for 2015 taxes, according to the IRS. Most often those exemptions came from people whose income was so low (less than $10,350 for an individual) that they are not required to file a tax return, or from Americans who lived abroad for most of the year, or from people for whom the cheapest available insurance was still unaffordable (costing more than 8 percent of their household income).

The fine for 2016 taxes is the greater of $695 per adult or 2.5 percent of household income. Fines for children who lack insurance coverage are half the amount for uninsured adults. Fines are pro-rated by the number of months each person was uninsured.

The maximum fine is $2,676; that is the national average cost of a "bronze" level insurance plan available on the health exchanges. But most people do not pay fines that are anywhere near that high. Last year, according to the IRS, an estimated 6.5 million tax filers paid a fine that averaged $470.

If you bought your own insurance from the federal marketplace or a state health insurance exchange and you got a federal tax credit to help pay for that coverage, you have to take another step before you can file your taxes.

People who got those tax credits must fill out a form that "reconciles" the amount of subsidies they received based on their income estimates with the amount they were entitled to according to their actual income reported to the IRS.

In tax filings for 2015, about 5.3 million taxpayers had to pay the government because they got too much in tax credits, compared to 2.4 million who got additional money back. But among those who underestimated their incomes and had to pay back some of those tax credits, 62 percent still received a net refund on their taxes.

So it wasn't that long ago that health insurers could deny someone coverage if they had a pre-existing condition. These are some of the insurance companies' most expensive consumers. To learn more about how this has changed and how it affects our taxes, we turn now to Julie Rovner of Kaiser Health News. Julie, welcome to the program.

JULIE ROVNER, BYLINE: Thank you.

WERTHEIMER: So the Affordable Care Act protects people with pre-existing conditions. They cannot be denied coverage, but how does it do that?

ROVNER: Well, the principal way that it does it is by trying to get more people into the insurance pool so the insurers won't just have the sick people buying coverage. And the main way it goes about getting more people into the insurance pool is this individual mandate that says, you either have to have insurance, or you have to pay a tax fine. And that's why insurance is now on everybody's taxes.

WERTHEIMER: So here's the big question. With everything that's been going on with the health care law over the past few months, are the law's tax requirements still in force?

ROVNER: Yes, they are. Nothing has actually been repealed or formally changed in the law yet, so everybody has to do something. It's basically three groups of people. For most people, they'll just have to check a box that said, yes, I had insurance. People who didn't have insurance or who didn't have it for longer than three months during the year might have to pay a penalty. And people who bought their insurance through the health exchange under the law - and if they got tax credits, they actually have to fill out yet another form to reconcile how much they got in tax credits with how much they should have gotten.

WERTHEIMER: Julie, what does it mean that President Trump then ordered federal agencies to reduce the burdens of the health law.

ROVNER: Well, he did indeed do that through an executive order, but he can't change the law itself. So the only real change that's been made so far is that the IRS has said that they wouldn't send your return back if you didn't check that box saying whether or not you had health insurance. It's not really a change because the IRS hasn't been kicking back returns for the last two years, but this year, they were going to, and they decided not to because of the executive order.

WERTHEIMER: So let's take these one at a time. If you had health insurance last year, what do you need to do?

ROVNER: You just need to check that box on your 1040 form that says you had insurance, and you're done.

WERTHEIMER: And if you did not have insurance?

ROVNER: Well, then you might have to pay a fine. Now, the fines have been phasing in gradually. Twenty-sixteen is the first year for what's supposed to be the permanent amounts. It's the greater of $695 or 2 and a half percent of your income if you didn't have insurance for the entire year. It's done by the month. The IRS said 6 and a half million people paid fines last year that averaged $470, although that was far less than the 8 million who paid fines the first year the requirement was in effect.

WERTHEIMER: Now, you said if you didn't have insurance, you might have to pay a fine. Who does not have to pay a fine?

ROVNER: Well, there are lots of ways to avoid the fine. Last year, almost 13 million people claimed an exemption from having to pay. The most popular reason was that they didn't earn enough to have to file an income tax return in the first place. Also, citizens living abroad didn't have to pay a penalty. Or if you filed for bankruptcy or if the cheapest health plan available to you would cost more than 8 percent of your income - and there are lot more exemptions.

WERTHEIMER: So what if you bought insurance on a health exchange and had help from the government to do it.

ROVNER: Well, these are the tax credits that we've been hearing so much about. And if you got one of them, then you have to fill out a very complicated separate form to see if the tax credits you got from the government were too much or too little or just the right amount. Last year, for tax year 2015, more people ended up having to pay back tax credits than got additional money, although in most cases, even those who had to pay back tax credits, meaning they got too much, still got a refund overall on their taxes.

WERTHEIMER: So what can the government do to you if you don't pay?

ROVNER: Not very much. This was a big point of debate when Congress was writing the health law. They didn't want the idea of people getting thrown in jail for not having health insurance. So, basically, the IRS can deduct what you owe in health insurance tax credits from any tax refund you have coming overall, but they can't send people after you for money the way they can if you don't pay your regular taxes.

WERTHEIMER: Julie Rovner of Kaiser Health News, thank you very much.

ROVNER: You're very welcome.

WERTHEIMER: This story is part of a reporting partnership between NPR, WHYY's health show The Pulse and Kaiser Health News. Transcript provided by NPR, Copyright NPR.